HEROIN STUDY IS WORTH A TRY FOR THE SAKE OF ADDICTS AND SOCIETY

Instead of prostituting themselves or breaking into homes and cars,
some heroin addicts will soon be able to attend a clinic, where, as a
result of a bold experiment, they will be provided with free heroin.

Needless to say, the study is controversial and researchers need to
iron out a few ethical problems, but the experiment is worthwhile all
the same.

The study, part of the North American Opiate Medication Initiatives,
will begin in Vancouver and then expand to Toronto and Montreal.

In Vancouver, 158 heroin addicts will take part and will be randomly
assigned to two groups: 88 will get heroin along with methadone, while
70 will receive methadone only. A small number of subjects in the
heroin group will be given hydromorphone, which is similar to, but
distinguishable from, illegal heroin. As such, researchers will be
able to determine if the subjects are supplementing the hydromorphone
they receive with street heroin. Counselling services will also be
available to all participants in the study.

Although some critics object to the study on the grounds that it will
make it easier to become a heroin addict, it's important to note that
not all addicts are eligible to participate. Only those who have used
heroin for at least five years and who have previously failed
methadone maintenance treatment qualify.

As such, the trial is aimed at determining whether a combination of
heroin and methadone is a better treatment for hard-core addicts who
don't respond to methadone-only therapies.

In fact, although Vancouver is the first city in North America to
conduct such an experiment, similar trials have been completed in
Switzerland and the Netherlands and the results suggest that heroin
treatment can be effective for this small group of hard-core addicts.

The European experiments found that a significant percentage of
addicts receiving heroin improved their health and the quality of
their lives. Many entered abstinence programs, some found employment
and there was a drastic reduction in the criminal activity of those on
heroin maintenance. In fact, the Swiss experiment was so successful
that Swiss voters chose, in two referendums, to continue heroin
maintenance as part of a permanent program.

That's not to say that all heroin users ended their addictions once
and for all, or that all obtained gainful employment. But heroin
maintenance did prove to be beneficial for both the hard-core addicts
and for society, which saw drug-related crime and health care costs
reduced.

Despite the study's promise, it does pose some ethical challenges.
Since the trial lasts only a year, addicts will only be able to
receive heroin for that length of time even if heroin maintenance has
improved their lives. It would seem, then, that researchers would have
a moral obligation to continue providing heroin to successful users.

However, given the study's strict protocols, it will be beyond the
researchers' ability to provide heroin for more than a year. Any
development of a permanent heroin maintenance program is the
responsibility of the federal and provincial governments, and if the
heroin trials should prove successful, it's up to the researchers to
provide that information to the policy-makers. If the evidence is
incontrovertible, then politicians could well follow the lead of the
Swiss and establish a permanent clinic.

That said, it's possible the results of the North American initiative
won't mirror those of the European experiment. The results might well
reveal that methadone maintenance is the best form of therapy, even
for addicts most resistant to treatment.

But there's no way of knowing what treatment is most effective unless
we complete the study, and that, alone, is reason enough to test a
potentially efficacious new therapy.